Kentucky won't set nursing ratios

Lawmakers in Minnesota and Washington have passed laws in recent weeks limiting the amount of overtime nurses can be required to work. But Kentucky won't do the same just yet, as lawmakers have turned aside two nurse-staffing bills.

''We already have a nurse shortage. . . . Where are the people going to come from?''
Carol Ormay, Kentucky Hospital Association

FRANKFORT -- How many hours can a hospital nurse work and still treat patients safely? And how many patients can one nurse safely care for?

Those have traditionally been matters for hospital officials to determine. But that is changing, as state governments become more concerned about patients tended by tired or overworked nurses.

This year, California became the first state to set minimum nurse-to-patient ratios for hospitals; other state legislatures are considering similar measures.

In the past two weeks, Minnesota and Washington became the fourth and fifth states to enact laws limiting the amount of overtime nurses can be required to work, and protecting them if they refuse.

Kentucky won't join those states, however -- at least not this year. Legislators turned aside two nurse-staffing bills during this session of the General Assembly, which ends soon.

The bills, backed by nursing groups, would have required hospitals and nursing homes to set and post their minimum staffing levels and be held accountable for them. It also would have restricted mandatory overtime if a nurse felt too tired to care for patients.

While the measures may have the laudable goals of protecting patients and easing nurses' burdens, they are seemingly undercut by the shortage of nurses.

Overstretched nurses are ''a serious problem, there's no question about it,'' Rep. Steve Nunn, a Glasgow Republican, said yesterday at a legislative hearing. ''But . . . if you don't work overtime, then who's going to be at the health-care facility to take care of people if we've got this shortage?''

Nunn was addressing four nurses and a nursing-union organizer who had spoken to the House Health and Welfare Committee in support of House Bill 91, a broad nurse-staffing measure. It was sponsored by Rep. Joni Jenkins, D-Shively, at the urging of the Nurses Professional Organization.

The committee took up the measure for discussion only and did not vote on it yesterday, which means it's dead for this session. But legislators indicated the subject of nurse staffing might deserve study before the next session.

A more narrow measure to limit mandatory overtime, sponsored by Rep. Mary Lou Marzian, D-Louisville, herself a registered nurse, also did not win approval. However, it was replaced with a measure directing an interim legislative committee to study the length of work shifts of nurses and other health-facility employees. That measure is pending.

Nurses and advocates for staffing requirements and overtime limits say they are needed because of sweeping changes in health care in recent years. Those changes include staff downsizing by some hospitals and movement by many nurses away from hospital duty to less stressful work, such as in doctors' offices and home health care.

Combined with greater opportunities for young women in careers other than nursing, the result has been fewer and older hospital nurses. And they are coping with a sicker population because less severe cases increasingly are handled as outpatients.

Today hospital nurses ''find ourselves frustrated, overworked and abused,'' including by being forced to work extra hours, Patty Clark, a longtime nurse at Norton Audubon Hospital and president of the NPO union, told legislators yesterday.

Such feelings are widespread. A survey conducted last year for the American Nurses Association found that more than 40 percent of nurses would not feel comfortable having a family member cared for where they work, and 54 percent would not recommend nursing as a profession. More than two-thirds cited inadequate staffing as a chief cause in the decline of care.

The Kentucky Nurses Association ''gets at least five to 10 calls a week from nurses who feel like they don't have the staff to cover'' a unit's patients safely, said Maureen Keenan, the association's executive director.

One of the nurses who addressed legislators yesterday, Suzette Sewell, said she was fired from Audubon in 1998 for refusing to work overtime. Now a nursing Ph.D. candidate at the University of Kentucky, she said the profession needs safeguards similar to those of the airline and trucking industries, in which pilots and drivers' travel time is limited to protect the public.

''We already have a nurse shortage -- a total health-care worker shortage,'' said Carol Ormay, a vice president of the Kentucky Hospital Association. ''Where are the people going to come from?''

''Hospital administrators don't need a bill to tell us what to do, because we do what's right anyway,'' said Teresa Parker, chief administrator of Norton Southwest Hospital and a registered nurse.

Parker said her hospital has guidelines for nurse-to-patient ratios for different units -- such as intensive care, where a nurse might handle two patients, or a medical-surgical floor, where six patients to a nurse might be normal.

But flexibility is needed, she said. If patients are sicker, or healthier, a different ratio might be appropriate. And without the ability to make nurses work overtime, she said, there might not be enough staff for the patients on hand.

Another concern is that staffing requirements could boost the cost of hospital care and thus health-insurance premiums.

Health insurance is such a large portion of employee-benefit costs today that anything that would boost premiums raises concerns, said Tony Sholar, lobbyist for the Kentucky Chamber of Commerce.

''Somewhere, there's a balance between the highest quality of care that we can get and what we can afford to pay for,'' he said.

Jenkins' measure does not go as far as the California law, which calls for state health authorities to set staffing minimums for different types of hospital units.

The staffing requirements -- for example, one nurse per eight babies in a well-baby nursery, one nurse per two burn-unit patients, and so on -- are not as stringent as the state nursing association wanted, but more strict than hospitals favored.

It does not look like the exodus from the bedside will abate anytime soon. I am willing to bet that over the next few months we will be seeing a spate of articles about how nurses continue to stream out of the profession.

Apr 2, '02

<''We already have a nurse shortage. . . . Where are the people going to come from?''
Carol Ormay, Kentucky Hospital Association>

From many of the 500,000 available nurses in this country (18% of the entire nursing workforce) who are experienced, licensed & not working in nursing today & who have said they would consider coming back to the bedside if & when working conditions & compensation are improved. Funny how the AHA just continues to refuse to acknowledge that those nurses exist. Im so sick of them duping the public into thinking there just are no nurses. We have more nurses now then we ever had before. They just REFUSE to take jobs with unacceptable conditions & inadequate comepnsation. Fix it & they will come.......& so will new students. Where is the email address to educate that person & the newspaper who wrote the story?

Apr 2, '02

<<How many hours can a hospital nurse work and still treat patients safely? And how many patients can one nurse safely care for?

Those have traditionally been matters for hospital officials to determine. >>

And thats part of the problem - hospitals refusing to give nurses a say in their own conditions of employment & the policies that affect their jobs & practice - ignoring their professional judgement and treating nurses as though they are puppets on a string. And they wonder why nurses dont want to work for them anymore?

Apr 2, '02

as a nurse in kentucky, i am dismayed at the health care politics in our legislation.

i was hoping there would be a light at the end of the tunnel for the state's overworked nurses...

<as a nurse in kentucky, i am dismayed at the health care politics in our legislation.

i was hoping there would be a light at the end of the tunnel for the state's overworked nurses...>

There still will be. Nurses in our state wrote a whisltleblower bill & got it thru the state assembly 3 yrs in a row but it was killed by the state senate. Then last yr they all finally passed the bill unanimously - and it was dropped by the Gov. The public backlash he got from nurses after doing that was instrumental in getting him to finally sign it YESTERDAY! So today, the whislteblower bill we wrote is now state law. Never say never.

We cant come & march on your state capitol but we can help you out from here - post your elected officials email addresses & we can help you educate them - with an avalanche.

ps

apparently, your states hospital association doesnt agree with you about your states overworked nurses. see their comments below

Last edit by -jt on Apr 5, '02

Apr 5, '02

Karen, just for the hell of it I wrote to that AHA VP whose link you posted. She had asked the newspaper where were nurses going to come from if they allowed safe staffing levels while they had a nurses shortage. I copied, pasted & sent her my post above - "From many of the 500,000 available nurses in this country (18% of the entire nursing workforce) who are experienced, licensed & not working in nursing today & who have said they would consider coming back to the bedside if & when working conditions & compensation are improved.........." She responded:

<<"Actually that is not true in Kentucky. Of our licensed nurses 94 percent are employed and 88 percent are working in hospitals. Your comments simply illustrate what I've said all along... there is no "one size fits all approach." You can't take a broad bush on the national level and expect the paint is going to stick when you examine the data thoroughly.">>

So I answered:

<<Your nurses may be working now but that doesnt mean they are satisified with the working conditions, that their working conditions are safe for them or their patients, or that they will encourage others to come in to the field. Nursing does not have enough new students coming in and yet the AHA lobbies against safe staffing levels so they can avoid having to make improvements that will attract new nurses and retain experienced nurses. So where are you going to get the staff? The Phillipines?

Did it ever occur to anyone at the AHA that the way to attract new students into the profession is to make the job better for their mothers? My 3 daughters do not want to be nurses when they see me come home exhausted, over worked, underpaid, or many times not allowed to come home at all.

If you think there is not a problem with staffing, forced overtime, unsafe conditions for nurses & pts in Kentucky just because you have 80-something % of employed nurses working in hospitals at the moment, you are out of touch with the nurses in your state.

WORKING CONDITIONS is the issue. Before the AHA addresses anything else that has to do with a nursing "shortage" it has to address WORKING CONDITIONS. The Horse has to come before the cart. >>>

And just so you all know what we are dealing with, here is her response to that:

<<"Your response is typical of a nurse with her head in the sand and who does not understand the health care delivery system as a whole and the demographics of the workforce. All you can see is your little portion.

Frankly...I don't think my daughter wants to do what I do because she sees me coming home exhausted from working 12 to 16 hours days including nights and weekends.

Good luck.">>

Moral of the story for Kentucky nurses (and all other nurses) -forget the AHA & go straight to the legislators to make sure they hear the truth.

Last edit by -jt on Apr 5, '02

Apr 5, '02

jt: god, i love it..your replies to AHA were appropro....i intend to contact my legislators as well as kna...it will be interesting to see what evolves, if anything, from our efforts. All I know is that personally, the high acuity and ratios of pts are killing our nurses...Unsafe doesn't even come close to what we are dealing with.

obviously, here in kentucky, there are those who are smoking "wacky tabacky"

moon<---a staff RN at one of the "hospital of distinction" and a "magnet hospital"

Apr 5, '02

Attended the NATIONAL STUDENT NURSES ASSOC. convention yesterday. Average age of RN senior student passing the Exhibitors area + PSNA booth was 35-40, many older 2nd and 3rd career students. Saw almost 2000 nurses....who will be there to care for us as we all retire at the same time/ leave due to worn out bodies???

VERY FRIGHTENING when seen by my own eyes!!!!!

Apr 5, '02

<All I know is that personally, the high acuity and ratios of pts are killing our nurses...Unsafe doesn't even come close to what we are dealing with.>

I know what you mean but apparently that "wacky tabacky" is making the rounds over there - hold on to your seat as you read the latest email sent to me by the VP of your state hospital association who was quoted in the article. I couldnt even believe this came from a "professional". Just had to share it with the ANA & asked them to forward it to the Kentucky Nurses Association. I had responded to her comments about her daughter not wanting to follow her footsteps either because she works long hours. I said something to the effect that at least she gets to go home. We are held hostage with threat of disciplinary action, loss of license, and termination if we leave at the end of our shift & this is a deterrent to nurses, causing them to avoid hospital jobs - so if you want nurses at the bedsides, you have to start by correcting these conditions. Obviously, she missed the point.

Remember this is a VP of your states hospital association talking:

<<My boss would just fire my ass and I wouldn't be able to get another job in this profession because I'd get blackballed for not being a team player. THINGS ARE TOUGH ALL OVER.

Yeah, someone would be able to take my place, but that doesn't help ME and, since there is no shortage of executives, I don't have a power base. You (nurses), however, should be able to get away with more and have more bargaining power but you (nurses) don't take advantage of that. Face it, even if we are talking raw numbers, there are a lot more nurses than health care executive in the world......

Nurses are your own worst enemies. You missed the chance during the last nurse shortage to become a strong voice in the health care arena.......

Until nurses speak with a coordinated voice and have hard data to back up their complaints - not anecdotal evidence - you aren't going to make changes. That's what defeated the nurses here in Kentucky. The legislators were sympathetic to their cause, but when all they can present are SOB STORIES with no backing and we can present documented data, they are not going to get anywhere.......

If we want to compare anecdotes, we can get as many staff nurses to present the opposite point of view and talk about nursing as a career and how great things as the folks on the other side can.......

Look - I don't know why you are bothering with this and why you are picking on me. You aren't going to change my mind and I'm not going to change yours. Why don't you complain to the Hospital Association of New York State (HANYS) or the Greater New York Hospital Association or even the AHA or the American Nurses Association?........

Have a good weekend. I'm working this weekend, are you? I have a 16-hour day to look forward to on Saturday and a 14-hour day on Sunday. I then have a 12-hour day on Monday and Tuesday......

How do you know that I'm not a nurse? I could be one of those nurses who is disaffected and is trying to change the system from the inside.

Are you involved in any type of organization? You really should be if you want to affect change.

Just trying to vent your frustration on me is not going to change things.

I'm not with the AHA by the way. I'm with the KHA - it's not the same thing.>>>>>>

Last edit by -jt on Apr 5, '02

Apr 5, '02

my final response to this woman:

- I am "bothering with this" because it is time the AHA heard from nurses and because in the newspaper article, YOU asked the question "where are nurses going to come from". I am replying to YOUR question. You made comments in the article and, as an RN, I am attempting to give you a view from where we stand. It is the same in every state.

Your title is as an executive with your state's hospital association. With this kind of attitude by hospital association executives towards nurses, is it any wonder our jobs are as they are, and nurses dont want to work in them? Your hostility towards nurses has really been an eye-opener here. I will be sharing this with nurses in Kentucky.

Thank you for your time. -

Last edit by -jt on Apr 5, '02

Apr 7, '02

Hi -jt. You're probably well aware that KY is one of those states with right to work and at will laws. Can you clarify for me? Does your 500,000 licensed nurses also include those who are working but not at the bedside?

I would like to know if you or someone can tell me or refer me to sources where I can get information on the breakdown of licensed nurses per state or region, percentage employed per setting, average age per state or region and so on? It would be interesting to compare this data.